PACS: The Next Generation

Carrie Vaughan, for HealthLeaders Magazine , November 12, 2009
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To avoid downtime, Iowa Health System in Des Moines load balances its systemwide PACS so that it resides in two data centers for short-term and long-term storage. That way if one data center goes down people can still access the images onsite at all times—although images stored in the long-term data center may take a few extra seconds to access, says Joy M. Grosser, CIO of the 26-hospital system. "Because we may also have outages on the network that we can't control, we also keep short-term storage of those images on-site for each of those facilities," she says.

Storage solutions
Being able to quickly access data in archived radiology studies is no longer negotiable in today's clinical environment. "There are some vendors that are not interested in migrating the old data," says Wiggins, adding that it's vital for his organization to access old studies to properly care for their patients. "Now I can pull up studies from 1997 to 1998 side-by-side with brand new ones and tell them immediately if [a tumor] is bigger or smaller," he says.

Historically, vendors have developed systems with a specific architecture strategy and they required customers to accommodate that strategy, says Grosser. But the marketplace has changed. Storage has become an integral part of the strategic planning process, she says. "Vendors are recognizing that especially for deep backend storage in the PACS world that we have a strategy for storage."

For example, Iowa Health, which recently converted to a PACS from San Francisco-based McKesson Corp., determined it wanted a vendor-neutral archive for its data centers so if it ever changes PACS vendors again it won't have to change the architecture, says Tony Langenstein, IT director of technology. "If we're speaking Portuguese, we don't have to learn Spanish."

Speed and stability
Physicians have less time and less time to spend on patient visits, says Grosser. "We wanted to make sure physicians are not waiting on computer systems and information in order to make decisions." To that end, Iowa Health built a 3,600-mile fiber-optic network that allows access from anywhere within the health system.

UUHSC has also upgraded its network from the T1 lines to a 10-gigabyte fiber-optic network. Previously, if someone asked Wiggins to review a study, he would have had to call them back after the study finally showed up on the computer. Now, he can access older studies in the same time it takes him to access the patient's clinical information. "I can pull it up and start telling them right away, 'I have a study from this date, and the tumor is bigger,'" he says.

Clinical functionality
Enabling radiologists and physicians to view images in a manner that suits their needs will be increasingly important in the years ahead. Grosser says the No. 1 clinical reason for changing PACS systems was the radiologists' and physicians' inability to work with recognized hanging protocol standards, which guide the way the images hang and how information flows. With the new PACS system, radiologists and physicians can customize their screen view of the images. "They came together as a group and said, 'As a profession, this is what we need to do for radiology,'" says Grosser.

Carrie Vaughan is senior technology editor for HealthLeaders Media. She may be contacted at

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